Croakey

John Mendoza’s damning assessment of Labor’s mental health history

This article was published today in the Crikey bulletin.

John Mendoza, Adjunct Professor of Health Science, University of Sunshine Coast, writes:

“On Tuesday Julia Gillard made her first policy announcement on mental health, Mental health: taking action to tackle suicide. The new PM has made the point publicly on several occasions that she understands the issues in mental health and has reminded us of her significant cultural capital in this regard.

I, like many in the sector, expected her to take a very different policy stance to her predecessor and to dig Minister Nicola Roxon out of the hole she continues to dig for herself on mental health.

In her speech to the Committee for Economic Development in Brisbane, Julia Gillard made much of Labor’s credentials in health reform, citing reform going back to Chifley and the PBS, Whitlam and Medibank and Hawke and Medicare. Fair enough.

She said “a nation’s health system is a measure of the nation itself… a test of a nation’s prosperity … and accessibility …a test of its fairness”. She set out the case that health reform is part of the Labor Party’s DNA. Seems reasonable.

Someone clearly didn’t point out to the PM that Ben Chifley actually signed a deal with the States to reduce funding for mental health in 1949 (“Mental Disease Benefits”) that significantly reduced services and beds for mental health care. Following a wave of national concern about over-crowed and “sub-human conditions” in mental health institutions, PM Menzies commissioned a national inquiry.

State Labor Governments (in every state except South Australia) resisted meeting then Federal Health Minister, Earle Page, to address the problems, which forced Menzies to set up the Stoller inquiry in 1954. Read More »

On mental health, who should you vote for? An indepth analysis

Further to a recent Croakey post comparing election mental health policies, here is a far more indepth analysis.

Sebastian Rosenberg, Senior Lecturer, Brain and Mind Research Institute, University of Sydney, writes:

“The recent high profile resignation of the chair of Minister Roxon’s own expert committee, John Mendoza, and the profile of the Australian of the Year Patrick McGorry have created a crescendo sufficient for mental health to register on the political Richter.

Mental health has moved out of the policy shadows and into the election spotlight.  Labor and the Coalition have laid out their election policies with regards to mental health and these can now be compared.

Relying on the always sophisticated approach of the ‘spendometer’, the comparison has been reduced by some to Coalition good, Labor bad because the former promises spending of $1.5bn, the latter a mere $277m.

Labor counters this by referring to the 1300 sub-acute beds it promised at April’s Council of Australian Governments meeting.

But in mental health, which represents some 13% of the total burden of disease, but attracts only some 6% of the total health budget, there can be no denying that money talks.

On closer inspection, the policies of both parties are largely focused on expanding investments in existing programs such as the headspace youth mental health service. Read More »

Is the obesity focus costing tobacco control?

In the United States, tobacco control is losing out to the focus on obesity, according to Croakey’s Washington correspondent, Dr Lesley Russell.

She writes:

“In the race for preventive health-care dollars from foundations, charities and federal and state governments, the increasing focus on obesity has meant that anti-tobacco efforts are losing out.

Yet cigarette smoking remains by far the most common cause of preventable death and disability in the United States.

Important strides have been made in tobacco control, in terms of both interventions (tax hikes and laws creating smoke-free workplaces) and outcomes (smoking prevalence that has more than halved since the early 1960s), so it is tempting to believe that the battle is largely won and that we should move on to other pressing public health issues.

One in five Americans still smoke, but one in three Americans is obese.  However, tobacco does kill four times as many people as obesity does. (The figures are almost identical for Australia)

A recent article in the New England Journal of Medicine highlighted this issue and the continuing need to support anti-tobacco efforts. Read More »

Bored? Uninspired? Depressed? This book may help you survive the election campaign

For those feeling uninspired, unimpressed and downright disappointed in the election campaign, have we got a book for you….featuring some fresh ideas about health policy, amongst other things.

Jennifer Doggett, a Fellow of the Centre for Policy Development, writes:

“Anyone frustrated by the lack of debate on health policy in the election campaign might be interested a new ebook from the Centre for Policy Development called More than Luck: ideas Australia needs now, released yesterday.

In the health chapter of this book, I’ve pulled together some fresh and innovative solutions to perennial problems in health policy and suggested some strategies for addressing gaps in the current reform agenda.

For example, in relation to the private health insurance rebate I’ve suggested that the current subsidy could be re-directed to give all low and middle income earners an annual $600 ‘health rebate’ to spend on health care of their choice.

This would be both more efficient and more equitable than the current rebate system which does not benefit many people on low incomes as they cannot afford rising health insurance premiums or the high out-of-pocket costs of private health care. It would allow families to use their rebate to meet the cost of basic medical care, such as gap payments for GP visits and prescription medicines and to fund dental and allied health services without the restrictions and caps placed on rebates by private health funds. Read More »

Mental health: who is offering the best election deal?

In a stroke of incredible timing, the Insight show on SBS tonight had an impressive selection of mental heath experts, consumers and carers to weigh up the mental health election policies of Labor and the Coalition.

Surely it couldn’t have been a complete coincidence that the PM today announced funding for suicide prevention measures, and requirements for Medicare Locals and Local Hospital Networks to report on the performance of mental health services. (Her full speech, which also canvasses broader health issues, is here.)

The overall consensus at Insight was that the Coalition’s mental heath policies deserved higher marks, and that this would prove an electoral winner for them. GetUp, which has made mental health one of its four top election issues, said its polling showed the Coalition policy was rating well.

Even Senator Rachel Siewert from the Greens plumped for the Coalition’s policy as the best major party policy “at the moment”.

The former NSW Liberals leader and director of Lifeline, John Brogden, was one of the few arguing the case for the Government, in the wake of its pledge of extra funds for Lifeline. “I’d be very happy to endorse any political party that supports Lifeline,” he said. Read More »

Will preventative health issues ever figure in the election campaign?

Finally, we’re getting a little election campaign action on health. As you’ve no doubt heard, the PM today announced a series of mental health initiatives (stay tuned for more comment on these in a later Croakey post).

But the Parents Jury is wishing for much more attention to some bigger-picture health issues.

Caitlin Syrett, Project Officer of The Parents Jury, writes:

“In May, federal Health Minister Nicola Roxon declared that “increasing our action on preventative health has never been more important” (In the response to the National Preventative Health Strategy, May 2010).

So why at this time, when the major political parties are outlining their visions for the future of Australia, has no one commented on preventative health?

Around 60% of Australian adults are overweight or obese and if current trends continue without solid intervention, it is predicted that our national figure will blow out to 75% by 2025.

Obesity and its associated chronic conditions such as type 2 diabetes, some cancers, heart disease and mental health are the greatest health issues. They will put an enormous strain on our health care system and the national economy for decades to come. It is predicted that the cost of lifestyle-related cases of type 2 diabetes alone will quadruple to $8 billion by 2032.

If the incoming federal government is genuinely concerned about the health of Australians, and the strength of the health system and the economy, it must get to the root of the problem and start talking about prevention.

Read More »

What to make of Family First’s binge drinking policy?

Family First has announced a policy to tackle binge drinking. So what does the public health crowd make of it?

Sarah Jaggard, Community Mobilisation Policy Officer at the Australian Drug Foundation, might be more optimistic about the policy if it weren’t for some recent history.

She writes:

“I felt vaguely excited when I read in Family First’s recent binge drinking policy statement that they want to tighten secondary supply laws to stop people other than parents from giving alcohol to underage drinkers.

Many of us have been advocating long and hard for a change in legislation to protect all Australian minors from alcohol related harm, so when a political party shows its support, I feel like we might actually be making a dent in Australia’s collective political subconscious.

Secondary supply refers to the provision of alcohol to people under the age of 18, usually by an adult who is not employed to sell it.  In NSW, QLD and Tasmania, an adult must not supply alcohol to a minor at a private place unless the adult is a parent or guardian or has specific permission of a parent or guardian of that young person. However, in some jurisdictions persons under 18 years can be supplied with, and drink, an unlimited amount of alcohol in private settings.  This has lead to severe injuries and death.

But then, as I thought more about the Family First policy, it all came flooding back:  the alcopops tax brouhaha.  First let me set the context for you. Read More »

Why everyone wants you to eat more…the problems confronting our forthcoming dietary guidelines

As reported in a recent Croakey post, an NHMRC committee is in the process of drafting new dietary guidelines. This is inevitably an incredibly fraught and contested process.

There are so many powerful players with an interest in encouraging us to eat more of whatever it is they sell.

Often these marketing campaigns are dressed up as health campaigns – you only have to visit your local butcher to see how clever the meat industry has been in this regard (or look at the advertising in the medical magazines). Their extensive PR and marketing campaigns indicate how seriously the industry is taking the health and environmental sustainability concerns that are increasingly being raised about meat-rich diets.

Researchers, too, often have an interest in encouraging a focus on their favourite nutrients, sometimes at the expense of the bigger picture.

There are very few powerful voices with an interest in telling us to eat less.

Yet clearly, for the sake of our ever-expanding waistlines, this is a message that most of us need to hear, loud and clear. Nor is over-consumption of food and drink, particularly the highly processed and packaged varieties, a recipe for planetary health.

The implications for public health and dietary guidelines of this power imbalance — between the eat more versus the eat less brigade — are spelt out by the US public health nutritionist, Professor Marion Nestle in her 2003 book Food Politics. If you are interested in food and health more broadly, it’s essential reading.

I asked Marion Nestle if she’d write for Croakey about the role of environmental sustainability as a criteria for dietary guideline development in the light of this recent editorial from The Australian.

She said she was too busy but suggested I quote from relevant posts on her blog.

Here are a few snippets:

On the 28 June, she blogged about the new Dietary Guidelines Advisory Committee report released earlier this year in the US (the US guidelines can be downloaded in full here if you have access to Google documents)

She notes that the US committee’s report is advisory. From 1980 through 2000, dietary guidelines advisory committees actually wrote the final US Dietary Guidelines. No more. Since 2005, the sponsoring agencies decide what the Dietary Guidelines will say.

She notes:

“Only once does the report say the clear and simple: “Avoid sugar-sweetened beverages” (p. 65).  Nowhere does it explicitly say to eat less steak, hamburger, French fries, pizza, cookies, or ice cream.

Like previous editions of the Dietary Guidelines, this one talks about foods in the context of eat more (fruits and vegetables).  For eat less advice, it switches to nutrients.  I’d call this obfuscation (and politics).

But the report—for the first time—emphasizes environmental influences on obesity:

The 2010 DGAC recognizes that the current food environment does not adequately facilitate the ability of Americans to follow the evidence-based recommendations outlined in the 2010 DGAC Report. Population growth, availability of fresh water, arable land constraints, climate change, current policies, and business practices are among some of the major challenges that need to be addressed in order to ensure that these recommendations can be implemented nationally.

What business practices?  It doesn’t say.  It does, however, recommend:

  • Improve foods sold and served in schools, including school breakfast, lunch, and afterschool meals and competitive foods so that they meet the recommendations of the IOM report on school meals….
  • Increase comprehensive health, nutrition, and physical education programs and curricula in US schools and preschools, including food preparation, food safety, cooking, and physical education classes and improved quality of recess….
  • Remove sugar-sweetened beverages and high-calorie snacks from schools, recreation facilities, and other places where children gather.
  • Develop and enforce responsible zoning policies for the location of fast food restaurants near schools and places where children play….

This is excellent advice.  But how about some suggestions about what individuals might do about it?

The report says little about food marketing.  Beyond “Develop and enforce effective policies regarding marketing of food and beverage products to children…,” the report says virtually nothing about the well documented impact of food marketing on children’s food choices, dietary intake, and health.  Unless I missed it someplace, the research review does not cite the Institute of Medicine’s 2006 landmark report, Food Marketing to Children and Youth: Threat or Opportunity.

It buries the need for policy changes in long wordy lists.  It states the needs for low-income Americans to have access to and afford healthier foods; to produce fruits, vegetables, and grains sustainably; to ensure household food security; to promote sustainable aquaculture; and to encourage the food service industry to serve healthier foods and smaller portions.  It does not—and perhaps cannot—recommend policy changes to achieve these important goals.

Overall, the report contains plenty of material for food, nutrition, and health advocates to work with, but you have to read between the lines to find it.”

***

Just last week, on the 21 July, Nestle wrote that the committee’s report and its advice about health and sustainability must “come as a serious challenge” to the meat industry.

The report recommends:

Shift food intake patterns to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts, and seeds. In addition, increase the intake of seafood and fat-free and low-fat milk and milk products and consume only moderate amounts of lean meats, poultry, and eggs.

Nestle advised: Keep an eye on the “eat less meat” theme.  She said: “My guess is that we will be hearing a lot more about it.”

****

Meanwhile, as the NHMRC committee continues its work, expect to hear plenty more from the various groups with an interest in telling us to eat more – for the sake of our health, of course.

It’s one dish that I’d suggest washing down with a large bucket of salt.

Unpicking the Oz’s recent splash on NHMRC’s “green diet push”

Last week The Australian newspaper splashed with this story about a “green diet push” which accused the National Health and Medical Research Council, which is currently developing new national dietary guidelines,  “of subverting food science to fit a green agenda”.

The paper followed up with a particularly ill-informed editorial under the headline “Social engineers want to force-feed us dogma for dinner”.

But, as suggested by the article below by nutritionist Dr Rosemary Stanton, it seems like yet another example from this newspaper of not letting the facts stand in the way of an ideological agenda.

She writes:

Last week, an article in The Australian criticised the National Health and Medical Research Council for including environmental sustainability in their considerations when formulating Australia’s dietary guidelines. The chief complainants were the Heart Foundation, CSIRO and the Australian Food and Grocery Council. AFGC thought the NHMRC should stick to ‘science’ rather than stray to areas where they had no expertise, such as environmental sustainability.

The moans were misplaced. The draft document that caused the angst was titled ‘A new food guidance system for Australia – Foundation and total Diets’. It was not the dietary guidelines and made no recommendations.

Read More »

Is home-grown the best, when it comes to WA Health?

Western Australia has so far been the standout in refusing to do a deal with the Feds on national health reform. While this has been widely attributed to the partisan politics involved, perhaps there are broader cultural issues also at play?

The West has been known to regard those self-absorbed Easterners with some suspicion.

Professor Gavin Mooney has been wondering why the WA Health Department has a tendency to appoint from the home-team. He writes:

“The WA Health Department has a new Director General – or rather the Acting DG, Kim Snowball, has been appointed permanently.

This position carries a salary of $540,000 – not bad in Australian terms and indeed international terms for heading up a health service for just 2 million people.

Here in the West, we’ve had a few different Health DGs in recent years. Interesting that each time the post is to be filled, it is indicated that it is to be advertised internationally. Maybe that is true but what is intriguing is that, on each of the last four occasions, the position has been filled by a local lad, local not just to Australia but local to WA. Read More »